Me kōrero tātou mō te Pouri Ātete-Maimoatanga!

Tērā pea kua pāngia koe e te pouri mō ngā marama, tae noa ki ngā tau. Kua kite koe i te tākuta, ā, kua tangohia e koe ehara i te kotahi engari e rua ngā rongoā mō te wā kua whakaritea, engari kāore anō tō pouri, tō kore hiahia ki tetahi mea, tō pouri rānei e kore e taea te mau. Kātahi pea ka pāngia koe e te mea e kiia nei ko te "Treatment-Resistant Depression" (TRD). Kaua e mataku ina rongo koe i taua ingoa, ehara i te mea "kāore e taea te rongoā." Heoi, ka roa pea te wā ki te kimi i te rongoā tika māu. Me kōrero tātou mō tēnei mea me te taipitopito me te tino māmā i tēnei rā.

He aha tēnei mea e kīia nei ko te pouri ātete-maimoatanga?

He whakarāpopototanga noa iho, ko te 'pōuri ātete-maimoatanga' he wāhanga iti o te Mate Pōuri Nui (MDD). Ka kitea tēnei mate ina pāngia koe e te pōuri, ā, kei te tango koe i te iti rawa e rua ngā rongoā ārai pouri tuatahi, i te horopeta kua tohua me te wā kua tohua (neke atu i te 6 ki te 8 wiki) , engari kāore ō tohu e pai ake ana.

Ko te tikanga, ka tohua tuatahitia e ngā tākuta ngā rongoā mai i te rōpū SSRI (Selective Serotonin Reuptake Inhibitors) SNRI rānei (Serotonin and Norepinephrine Reuptake Inhibitors). Nā te mea, ki te whakaritea ki ētahi atu rongoā ārai pouri, he iti ake ngā pānga taha o ēnei, ā, kāore i te tino kino ngā pānga taha. I ētahi wā, ahakoa te hunga i pai te urupare ki ngā rongoā ārai pouri i mua, ka pāngia pea rātou e te TRD i muri mai. Ahakoa te ingoa, he maimoatanga anō hoki mō tēnei, engari ka roa pea te wā ki te kimi i te mea tika māu.

He pēhea te noa o tēnei āhuatanga?

I mōhio koe tata ki te 30% o te hunga kua tāpaetia he mate pouri nui (MDD) ā, kua rongoatia mōna, he TRD anō hoki? Ko te MDD tētahi o ngā mate hauora hinengaro tino noa o te ao. Ka pāngia e te 5% me te 17% o te tangata i tētahi wā o ō rātou oranga. Nō reira, kia mahara kāore koe i te mokemoke.

He aha ngā tohu o tēnei?

He rite tonu ngā tohu o te hunga whai TRD ki te hunga whai MDD. Arā, ko ngā āhuatanga pēnei i te pouri tonu, te pouri, ngā mate moe (kāore e moe, kāore rānei e taea te moe), me ngā huringa o te hiahia kai (kāore e hiahia ki te kai, he nui rawa rānei te kai).

Heoi, he mea noa ake ēnei i waenga i te hunga whai TRD:

• Ka kaha haere ngā tohu.
• Ka roa te wā e pāngia ai te pouri.
• He āhuatanga e kiia nei ko te "Anhedonia." Ko tōna tikanga kāore e taea e koe te whiwhi i tētahi ahuareka mai i ngā mea i hari ai koe, i te koa rānei i mua. Whakaarohia, kei te whakarongo koe ki tāu waiata tino pai, kei te kōrero rānei ki tētahi hoa, engari kāore he kare ā-roto e pā ana ki a koe.
• Te pikinga ake o te auau o ngā wā pouri i te oranga o te tangata.
• Te nui rawa o te manukanuka .
• Whakaaro whakamomoriA he nui ake ngā tūponotanga ki te whakamātau.

He mea nui: Mena kei te whakaaro koe, kei te whakaaro rānei tētahi e mōhio ana koe ki te whakamomori, waea atu ki te Rārangi Whakamomori me te Rārangi Ora mō ngā Wā Pōuri i te 988. Kei te wātea tētahi hei āwhina i a koe, 24 hāora ia rā. Ka taea hoki e koe te toro atu ki tētahi tākuta, ki tētahi kaitohutohu hauora hinengaro rānei i te wā e taea ai.

He aha tēnei e tupu nei? He aha ngā take?

Ina hoki, kāore anō kia tino mōhiotia e ngā kairangahau he aha te take kāore ai te pouri o ētahi tāngata e aro ki te rongoā. Pērā i te korenga o te take kotahi mō te pouri, he maha ngā āhuatanga, tae atu ki ngā awe ira me ngā huringa o ngā matū roro, e whai wāhi ana ki tēnei āhuatanga.

Engari, ki tā rātou whakaaro, ka pā nui te ahotea mau tonu ki tēnei. Me pēhea koe e mōhio ai? He pūnaha nui kei roto i ō tātou tinana e kiia nei ko te Hypothalamic-Pituitary-Adrenal (HPA) axis. Koinei te mea e āwhina ana i a tātou ki te urutau ki te ahotea. Nō reira, ka taea e te ahotea tonu te whakarerekē i te mahi a tēnei HPA axis. Ina tupu tēnā, ka nui haere te kino o te pouri, ā, ka uaua ake te rongoā.

Ko wai te mea tino mōrearea?

Kua whakaatuhia e ngā rangahau, ki te whakaritea ki te hunga whai MDD e aro ana ki te rongoā, he nui ake te tūponotanga o te hunga whai TRD ki te pāngia e ēnei āhuatanga tinana e whai ake nei:

• Ngā mate pūnaha ārai mate (arā, ngā mate e whakaekehia ai e te pūnaha ārai mate o te tinana a ia anō).
• Te mate tairoi.
• Mate ngakau.
• Te mate roro (arā, ngā mate e puta ana i roto i ngā oko toto e tuku toto ana ki te roro).

Ehara i te mea ka pāngia te hunga katoa e pāngia ana e ēnei mate e te TRD, engari he āhuatanga mōrearea pea ēnei.

Me pēhea te tautuhi tika a ngā tākuta i tēnei?

Kāore i te tino mārama te tautuhi i te mate o te TRD. Heoi, ko te nuinga o ngā tākuta e tautuhi ana i tēnei mate ina kāore anō koe kia kite i tētahi whakapainga i roto i ō tohumate pouri i muri i te tango i te iti rawa e rua o ngā rongoā ārai pouri e whakamahia ana e koe i tēnei wā. He maha ngā tākuta e whakaaro ana ki ēnei hei rongoā ārai pouri tuatahi:

• Ngā SSRI
• Ngā SNRI
• Pūporopiona
• Mirtazapine

I te nuinga o te wā, me whakamahi koe i tētahi rongoā mō te ono ki te waru wiki pea kia kite ai mēnā e whai hua ana, kāore rānei.

Mena kei te tango koe i ngā rongoā e rua, ā, kāore anō kia pai ake te āhua, ka tukuna pea koe e tō tākuta ki tētahi tohunga hinengaro . I reira, ka tangohia e ia he hītori hauora me te hauora hinengaro. Kei roto pea i ēnei:

• Ngā rongoā katoa e tangohia ana e koe i tēnei wā (nā te tākuta i whakahau, ngā rongoā kore-tohu, ngā rongoā otaota, tae atu ki ngā rongoā narkotika)Pātai atu mō tēnei. Nā te mea ka taea e ētahi rongoā te whakararuraru i te whai huatanga o ngā rongoā ārai pouri, te whakanui ake rānei i te pouri.
• Ka matapakihia e rātou mēnā kei te tika tō tango i ngā rongoā ārai pouri me ētahi atu rongoā, me te mea hoki kua whakaritea .
• Ka tirohia e rātou mēnā kua whiwhi koe i te rongoā hinengaro, i te kōrerorero rānei , ā, mēnā kua āwhina i a koe ki te whakatau i tō pouri.
• Ka taea e ētahi āhuatanga tinana, pērā i te mate tairoi me te mamae mau tonu, te whakararu, te whakanui rānei i te pouri, nō reira ka tirohia mēnā kei te pouri.
• Ka tirohia e rātou ngā raruraru pēnei i te whakamahinga tarukino .
• Whakaarohia mēnā he nui ake te tūponotanga kia tautuhia ō tohumate ki tētahi atu mate hauora hinengaro (hei tauira, te mate hinengaro rua, te mate tuakiri rānei) .

I muri i te matapaki i ēnei mea katoa me te whakahaere i ngā whakamātautau e tika ana, ka whakatauhia e tō tākuta mēnā kei a koe te 'TRD'. Kātahi ka āwhina ia i a koe ki te kimi i te huarahi maimoatanga pai rawa atu māu.

Nā, he aha ngā maimoatanga mō tēnei?

He maha ngā huarahi hei whakahaere i te TRD. Tērā pea ka roa te wā e puta ai ngā hua e hiahiatia ana, engari kaua e mutu te tumanako.

Tuatahi, ka whakamātau pea tō tākuta hinengaro i ēnei mea:

• Hoatu te rongoā ārai pouri e roa ake ana te wā e pau ana ki a koe i tēnei wā.
• Whakanuia te horopeta o te rongoā ārai pouri raina tuatahi e tangohia ana e koe i tēnei wā.
• Tāpirihia he rongoā ārai pouri mai i tētahi atu akomanga. Kātahi ka rua ngā rongoā e tangohia ana e koe i te wā kotahi.
• Whakatenatenahia koe kia tūtaki ki tētahi tohunga hinengaro , kia whiwhi ai i te rongoā hinengaro . Tērā pea ka roa te wā ki te kimi i tētahi kaiwhakaora hinengaro e "mārama ana ki a koe". He rerekē anō hoki ngā momo rongoā hinengaro.

He aha tāu e mahi ai i muri mai ina kore e whai hua ngā maimoatanga noa?

Ki te kore e whai hua ēnei tikanga taketake, ka tūtohu tonu tō tākuta hinengaro i tētahi momo rongoā rerekē, i tētahi huinga rongoā, i tētahi tikanga maimoatanga rerekē rānei.

I tēnei wā, e rima ngā rongoā kua whakaaetia e te US Food and Drug Administration (FDA) mō te TRD:

• Aripiprazole (Abilify®) me Brexpiprazole (Rexulti®): He rongoā antipsychotic o te whakatupuranga tuatoru ēnei. Ka taea e rāua te whakaiti i ngā tohu o te pouri mā te pā ki ngā taumata o te serotonin me te norepinephrine i roto i tō roro.
• Quetiapine (Seroquel®) me Olanzapine (Zyprexa®): He rongoā antipsychotic o te reanga tuarua ēnei. Kua whakaaetia te Quetiapine hei maimoatanga tāpiri mō te TRD me ngā antidepressants. Kua whakaaetia te Olanzapine ina hoatu ngātahitia me te Fluoxetine (Prozac®). Ka āwhina rāua ki te whakaiti i ngā tohu o te pouri mā te pā ki ngā taumata dopamine i roto i te roro. Ka taea hoki e ēnei rongoā te whakamoe.
• Rehu ihu Esketamine (Spravato®): He mea hanga tēnei mai i tētahi matū e kiia nei ko te ketamine. I whakaaetia e te FDA i te tau 2019 hei rongoā tāpiri mō ngā pakeke e pāngia ana e te TRD, me tētahi rongoā ā-waha hei ārai i te pouri. Ka taea e te Esketamine te tīmata ki te whakaiti i ngā tohu o te pouri i roto i ngā haora e rua i muri i te tangohanga. Heoi, nā te mea ka taea e ia te whakararuraru i te hiamoe nui (whakamoe), te wehewehe (te ngaronga o te mōhio ki tō wāhi, ki te aha rānei e tupu ana), ā, nā te mea ka taea te whakamahi kino, ka hoatu noa tēnei rongoā i raro i te tirotiro a te tākuta i roto i te whare hauora. Ka aroturukihia koe e ngā tākuta mō ngā haora e rua i muri i te tangohanga o te rongoā.

He aha atu ngā maimoatanga kua whakaaetia e te FDA?

Kua whakaaetia hoki e te FDA ēnei maimoatanga mō te TRD:

• Te whakaora hiko-ā-rangi (ECT): He tikanga hauora tēnei. I roto i tēnei, ka tukuna ngā hiko tino ngawari mā roto i tō roro, ka puta he hopu iti. Ka whakaoho tēnei i ngā pūtau io, ā, ka puta he huringa i roto i te roro ka whakapai ake i tō wairua.
• Te whakaohooho aukume whakawhiti angaanga auau (rTMS): He maimoatanga kore-whakaeke tēnei. I roto i tēnei maimoatanga, ka whakamahia he koiri aukume hei awe i te mahi hiko tūturu o tō roro. Ka taea e tēnei te whakaputa huringa ki ngā wāhanga motuhake o te roro ka pā ki tō wairua.

He kōwhiringa maimoatanga anō kei reira?

He maha atu anō ngā huarahi maimoatanga mō te TRD, engari kāore pea ēnei i te whānui te wātea, kei roto rānei i te wāhanga rangahau:

• Te whakaohooho roro hōhonu (DBS): He tikanga hauora anō hoki tēnei. I konei, ka tukuna he iahiko ngawari ki tētahi wāhanga motuhake o tō roro. Ka whakaohohia e tēnei hiko ngā pūtau roro i taua wāhi, ka taea te whakaora i ētahi mate, tae atu ki te TRD.
• Lithium (Eskalith®): Kua whakaatuhia e ngā rangahau ka taea e te tango i te lithium me te rongoā ārai pouri (hei tauira, citalopram) te whakapai ake i te TRD.
• MAOI (Ngā aukati monoamine oxidase): Koinei ngā rongoā tuatahi mō te pouri i kitea. Heoi, nā te maha o ngā here mō te kai, ngā pānga taha, me ngā āwangawanga mō te haumaru, ka tohua noa ēnei e ngā tākuta ina kore e angitu ngā rongoā katoa mō te pouri.
• Pramipexole (Mirapex®): He rongoā tēnei kua whakaaetia e te FDA mō te mate a Parkinson. Kua whakaatuhia e ngā rangahau ka taea e ia te whakaiti i ngā tohu pouri i roto i te mate a Parkinson. Tērā pea ka āwhina i te hunga whai TRD.
• Te whakaohooho i te io vagus (VNS):I konei, ka whakauruhia he taputapu e tuku ana i ngā pāoro hiko ngawari, auau ki tō roro mā te io vagus i tō kaki. Ka taea e tēnei te whakarerekē i ngā taumata o ētahi 'neurotransmitters' i roto i tō roro e whakahaere ana i tō wairua.

Kei te rangahau hoki ngā kairangahau i te psilocybin, he matū i tangohia mai i ngā harore whakaipoipo, hei rongoā mō te TRD.

He pānga taha kei roto i ēnei maimoatanga?

I te nuinga o te wā, he nui ake ngā pānga taha o ngā rongoā me ngā maimoatanga mō te TRD i ngā rongoā ārai mate tuatahi. Waihoki, ka rerekē rawa aua pānga taha. Ka kōrero tō tākuta ki a koe mō ngā pānga taha, ngā raruraru rānei ka pā ki ia whiringa maimoatanga. Kaua e mangere ki te pātai.

Ka taea te ārai i tēnei āhuatanga kei puta?

Nā te mea kāore ngā kaipūtaiao i te tino mōhio he aha te take o te TRD, he uaua ki te ārai i tēnei. Heoi, nā te mea ka whai wāhi pea te ahotea mau tonu ki tēnei, ka taea e koe te mahi i ēnei mea hei whakahaere i tō ahotea:

• Whakakorikori tinana i ngā wā katoa. Ahakoa he hikoi poto noa iho ka taea te whakapai ake i tō wairua.
• Kia pai te moe. He mea nui tēnei mō te hauora whānui.
• Whakamātauria ngā mahi pēnei i te whakaaroaro, te yoga, ngā mahi manawa, me ngā mahi whakangā uaua .
• Whakatakotoria he whāinga mō tō rā, mō tō wiki, mō tō marama hoki. Ina arotahi koe ki ngā mea iti, ka rite koe ki te mea kei a koe te mana whakahaere mō te wā me te wā roa.
• Whakaharatauhia te aro nui me te whakawhetai . Whakaarohia ngā mea pai o tō rā, o tō koiora rānei.
• Whakamātauria te kī "kāo" ki ngā kawenga tāpiri ina pukumahi koe, ina ahotea rānei.
• Kia mau tonu te whanaungatanga ki te hunga e whakamarie ana i a koe, e tautoko ana i a koe i te taha hinengaro, e āwhina ana hoki i a koe ki ngā mahi whai hua.
• Whakaarohia te kōrero ki tētahi kaiwhakaora hinengaro, ki tō tākuta rānei mō te ahotea.

Mena he pouri tōu kāore e taea te rongoā, he aha tāu e taea ai te mahi i te kāinga?

Haunga te rapu awhina hauora ngaio mō te TRD, he maha ngā mea ka taea e koe te mahi i te kāinga hei āwhina i te whakaiti i ō tohumate:

• Te whakakorikori tinana i ia wā, i ia wā.
• Te moe pai (kaua e moe nui rawa, kaua hoki e moe iti rawa).
• Te kai i tētahi kai hauora.
• Āta karohia te waipiro me ngā raau taero ehara i te rongoā. He mea whakapōrearea te waipiro.
• Te whakapau i te wā ki te hunga e arohaina ana e koe, e āwangawanga ana hoki.

Āhea koe me toro atu ki te tākuta?

Kia kitea rā anō e koe tētahi mahere maimoatanga whai hua mō te TRD e whai hua ana māu, tirohia me pēhea te mahi.Me toro atu koe ki tō tākuta i ia wā, i ia wā.

Haunga tēnā, kōrero ki tō tākuta i roto i ēnei āhuatanga:

• Mena ka pāngia koe e ngā pānga taha whakarihariha.
• Ki te kore ō tohu e pai ake, ki te kino haere rānei.
• Ki te mea kei te whakaaro koe ki te whakamutu i tō rongoā (kaua rawa e mutu te tango rongoā me te kore he tohutohu a te taote).

Ko te mea nui rawa atu me kī atu e koe

Ki te mea kei a koe te TRD, kia mahara tuatahi ehara i te mea ko koe anake . Tata ki te 30% o te hunga e pāngia ana e te pouri nui he mate tēnei. He maha ngā kōwhiringa maimoatanga mō te TRD, engari ka roa pea te wā ki te kimi i te mea e pai ana mōu. Ka tautokohia koe e tō tākuta, e tō tohunga hinengaro rānei i taua haerenga. Kaua e mutu te tumanako. Mā te tautoko me te maimoatanga tika, ka taea e koe te whakahaere i tēnei mate me te ora i te oranga pai ake.